Unravelling hidden threats of water disinfection: Toxicity evaluation and toxic products identification during diclofenac degradation.

Diclofenac (DCF) is a widely-used nonsteroidal anti-inflammatory drug that is routinely found in surface water bodies. While ozonation and ultraviolet (UV) radiation are commonly employed as disinfection methods in water treatment processes, the degradation of DCF in these processes occurs due to the strong oxidizing activity of the reactive oxygen species produced during both ozonation and UV radiation. Despite extensive studies reporting the removal and transformation of DCF through ozone and UV treatments, the potential hidden hazards of toxicity arising from these processes as well as the identification of the toxic transformation products have often been overlooked. In this study, various toxicities including microtoxicity, genotoxicity and antiestrogenicity were evaluated using multiple in-vitro bioassays. The transformation products were identified via ultra-performance liquid chromatography equipped with mass spectrometry (UPLC-MS). Correlation analysis was employed to gain deeper insight into the contributions of degradation products to overall toxicity. The results revealed that DCF possessed significant genotoxic and antiestrogenic effects, but displayed minimal microtoxicity. Microtoxic products such as those containing carbazole were generated during DCF degradation with ozone, UVA and UVC. Antiestrogenic products with dichloroaniline structures were observed in DCF ozonation but not in photodegradation by UVA and UVC. These findings highlighted the hidden risks associated with the disinfection of water containing micropollutants such as DCF.

Intelligent contour extraction approach for accurate segmentation of medical ultrasound images.

Introduction: Accurate contour extraction in ultrasound images is of great interest for image-guided organ interventions and disease diagnosis. Nevertheless, it remains a problematic issue owing to the missing or ambiguous outline between organs (i.e., prostate and kidney) and surrounding tissues, the appearance of shadow artifacts, and the large variability in the shape of organs. Methods: To address these issues, we devised a method that includes four stages. In the first stage, the data sequence is acquired using an improved adaptive selection principal curve method, in which a limited number of radiologist defined data points are adopted as the prior. The second stage then uses an enhanced quantum evolution network to help acquire the optimal neural network. The third stage involves increasing the precision of the experimental outcomes after training the neural network, while using the data sequence as the input. In the final stage, the contour is smoothed using an explicable mathematical formula explained by the model parameters of the neural network. Results: Our experiments showed that our approach outperformed other current methods, including hybrid and Transformer-based deep-learning methods, achieving an average Dice similarity coefficient, Jaccard similarity coefficient, and accuracy of 95.7 ± 2.4%, 94.6 ± 2.6%, and 95.3 ± 2.6%, respectively. Discussion: This work develops an intelligent contour extraction approach on ultrasound images. Our approach obtained more satisfactory outcome compared with recent state-of-the-art approaches . The knowledge of precise boundaries of the organ is significant for the conservation of risk structures. Our developed approach has the potential to enhance disease diagnosis and therapeutic outcomes.

Ultrasound Prostate Segmentation Using Adaptive Selection Principal Curve and Smooth Mathematical Model.

Accurate prostate segmentation in ultrasound images is crucial for the clinical diagnosis of prostate cancer and for performing image-guided prostate surgery. However, it is challenging to accurately segment the prostate in ultrasound images due to their low signal-to-noise ratio, the low contrast between the prostate and neighboring tissues, and the diffuse or invisible boundaries of the prostate. In this paper, we develop a novel hybrid method for segmentation of the prostate in ultrasound images that generates accurate contours of the prostate from a range of datasets. Our method involves three key steps: (1) application of a principal curve-based method to obtain a data sequence comprising data coordinates and their corresponding projection index; (2) use of the projection index as training input for a fractional-order-based neural network that increases the accuracy of results; and (3) generation of a smooth mathematical map (expressed via the parameters of the neural network) that affords a smooth prostate boundary, which represents the output of the neural network (i.e., optimized vertices) and matches the ground truth contour. Experimental evaluation of our method and several other state-of-the-art segmentation methods on datasets of prostate ultrasound images generated at multiple institutions demonstrated that our method exhibited the best capability. Furthermore, our method is robust as it can be applied to segment prostate ultrasound images obtained at multiple institutions based on various evaluation metrics.

Clinical study of transcranial sonography image characteristics in patients with obstructive sleep apnea.

OBJECTIVE: This study aimed to explore the relationship between patients with obstructive sleep apnea (OSA) from subgroups of varying severity and substantia nigra (SN) hyperechogenicity as well as cerebral blood flow detected by transcranial sonography (TCS). The study also explored if there were differences in damage of the SN and in the cerebral blood flow between the bilateral sides. METHODS: Right-handed men diagnosed with OSA by polysomnography were recruited from August 2018 to August 2020. The included patients were divided into 3 subgroups (mild, moderate, and severe OSA), and all patients underwent TCS. RESULTS: Among the 157 study patients (30 with mild OSA, 25 moderate, and 102 severe), the overall prevalence of SN hyperechogenicity was 15% (23/157). The hyperechogenicity detection rates were 3% (4/157) in the right SN subgroup and 13% (20/157) in the left SN subgroup, which were significantly different. The left side always had reduced blood flow on TCS (P < 0.05). No correlation was observed between the severity of OSA and the detection rates of SN hyperechogenicity (P > 0.05). CONCLUSION: Patients with OSA showed a higher detection rate of SN hyperechogenicity on the left compared with the right side. The left middle cerebral arteries had reduced blood flow, which was consistent with the more severe damage of the left SN. No relationship was observed between the severity of OSA and the detection rate of SN hyperechogenicity or hemodynamic parameters.

Ultrasound exploration of muscle characteristic changes and diabetic peripheral neuropathy in diabetic patients.

PURPOSE: Using brightness mode ultrasound combined with shear wave elastography, this study aims to detect structural and functional changes of the medial head of gastrocnemius (MG) in type 2 diabetes mellitus (T2DM) patients with or without diabetic peripheral neuropathy (DPN). METHODS: 149 T2DM patients (DPN group and non-DPN group) and 60 healthy volunteers (control group) were enrolled. We measured the absolute difference of fascicle length (FL), pennation angle (PA), and shear wave velocity (SWV) of both MG in neutral position and maximal ankle joint's plantar flexion and calculated ΔFL, ΔPA, and ΔSWV. These three parameters, along with muscle thickness (MT), were compared among the three groups. RESULTS: In the DPN group, the MG's MT, ΔPA, and ΔSWV were significantly lower than in the non-DPN group (p < 0.01); these parameters achieved the highest scores in the control group (p < 0.01). The area under the receiver operating characteristic curve of the combination of ΔSWV and ΔFL was the largest for predicting inpatients with or without DPN. CONCLUSIONS: Decreased muscle mass (MT) and muscle contractibility (ΔFL and ΔSWV) were detected in patients with T2DM, with or without DPN. ΔSWV and ΔFL of the MG showed high-diagnostic accuracy for DPN warning signs.

H-SegNet: hybrid segmentation network for lung segmentation in chest radiographs using mask region-based convolutional neural network and adaptive closed polyline searching method.

Chest x-ray (CXR) is one of the most commonly used imaging techniques for the detection and diagnosis of pulmonary diseases. One critical component in many computer-aided systems, for either detection or diagnosis in digital CXR, is the accurate segmentation of the lung. Due to low-intensity contrast around lung boundary and large inter-subject variance, it has been challenging to segment lung from structural CXR images accurately. In this work, we propose an automatic Hybrid Segmentation Network (H-SegNet) for lung segmentation on CXR. The proposed H-SegNet consists of two key steps: (1) an image preprocessing step based on a deep learning model to automatically extract coarse lung contours; (2) a refinement step to fine-tune the coarse segmentation results based on an improved principal curve-based method coupled with an improved machine learning method. Experimental results on several public datasets show that the proposed method achieves superior segmentation results in lung CXRs, compared with several state-of-the-art methods.

Ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy for treatment of frozen shoulder.

BACKGROUND: Frozen shoulder (FS), also known as shoulder adhesive capsulitis, is a musculoskeletal disorder associated with pain and functional disability. There is a lack of evidence on the optimal treatment strategy for FS. OBJECTIVE: The present study aimed to evaluate the effectiveness and safety of ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy for treatment of FS. METHODS: In this prospective randomized, double-blind, controlled study, 63 FS patients were recruited, and equally allocated to treatment group and control group. The treatment group was treated with ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy, while the control group was only treated with ultrasound-guided hydrodilatation of glenohumeral joint. The pain and mobility of shoulder, overall efficacy and adverse reactions were evaluated 3 months after treatment. RESULTS: At baseline, no significant difference in all characteristic value was found between the treatment group (n= 33) and control group (n= 30). Three months after operation, the joint's Active Range of Motion (AROM) and Constant-Murley Scale (CMS) scores in the experimental group were higher than those in the control group, and the coracohumeral ligament (CHL) thickness and the rate of hypoechoic thickening in rotator cuff space in the experimental group were lower than those in the control group (all P< 0.05). The amount of injection volume at the third hydrodilatation was significantly higher in the experimental group than that in the control group (15.8 ± 4.7 vs 12.2 ± 5.2, P= 0.03). After 2 times of treatment, the volume increment of glenohumeral joint Δ2 in the experimental group was greater than that in the control group (3.5 ± 1.8 vs 1.2 ± 1.6, P< 0.001). There were significant differences in the effective rate between the two groups (93.94% vs. 76.67%, P= 0.04). CONCLUSION: The ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy may benefit FS patients.

Clinically significant prostate cancer (csPCa) detection with various prostate sampling schemes based on different csPCa definitions.

BACKGROUND: Combining targeted biopsy (TB) with systematic biopsy (SB) is currently recommended as the first-line biopsy method by the European Association of Urology (EAU) guidelines in patients diagnosed with prostate cancer (PCa) with an abnormal magnetic resonance imaging (MRI). The combined SB and TB indeed detected an additional number of patients with clinically significant prostate cancer (csPCa); however, it did so at the expense of a concomitant increase in biopsy cores. Our study aimed to evaluate if ipsilateral SB (ipsi-SB) + TB or contralateral SB (contra-SB) + TB could achieve almost equal csPCa detection rates as SB + TB using fewer cores based on a different csPCa definition. METHODS: Patients with at least one positive prostate lesion were prospectively diagnosed by MRI. The combination of TB and SB was conducted in all patients. We compared the csPCa detection rates of the following four hypothetical biopsy sampling schemes with those of SB + TB: SB, TB, ipsi-SB + TB, and contra-SB + TB. RESULTS: The study enrolled 279 men. The median core of SB, TB, ipsi-SB + TB, and contra-SB + TB was 10, 2, 7 and 7, respectively (P < 0.001). ipsi-SB + TB detected significantly more patients with csPCa than contra-SB + TB based on the EAU guidelines (P = 0.042). They were almost equal on the basis of the Epstein criteria (P = 1.000). Compared with SB + TB, each remaining method detected significantly fewer patients with csPCa regardless of the definition (P < 0.001) except ipsi-SB + TB on the grounds of D1 (P = 0.066). Ten additional subjects were identified with a higher Gleason score (GS) on contra-SB + TB, and only one was considered as significantly upgraded (GS = 6 on ipsi-SB + TB to a GS of 8 on contra-SB + TB). CONCLUSIONS: Ipsi-SB + TB could acquire an almost equivalent csPCa detection value to SB + TB using significantly fewer cores when csPCa was defined according to the EAU guidelines. Given that there was only one significantly upgrading patient on contra-SB, our results suggested that contra-SB could be avoided.

The Value of Shadowing and the Twinkling Artifact in the Diagnosis of Ureteral Stones: A Single-center Study.

OBJECTIVE: To determine and evaluate the value of shadowing and the twinkling artifact (TA) for the diagnosis of ureteral stones. MATERIALS AND METHODS: Related ultrasound images from 117 patients with suspected ureteral stones were consecutively collected with optimized machine settings, confirmed by computed tomography and then retrospectively reviewed by 12 physicians who were classified into 3 groups according to their experience levels: elementary, intermediate, and advanced. The shadowing/TA grades were separately evaluated by all the participating physicians in a blinded manner, and the consistency was verified using Kendall's coefficient of concordance (Kendall's W). Furthermore, the diagnostic performance was compared among the groups stratified by physicians' clinical experience levels and ureteral stone sizes. RESULTS: Using shadowing/TA as indicators for ureteral stones, Kendall's W for the TA evaluation was higher than that for shadowing among all the participating physicians and subgroups (P <.05). Furthermore, with no difference in specificity at 100%, the sensitivity of the isolated TA was superior to that of shadowing in groups stratified by the physicians' clinical experience levels and stone sizes, respectively (P <.05). However, for the respective comparisons of shadowing and the TA among groups stratified by stone sizes, as ureteral stones became larger, the detection sensitivities all significantly increased (P ≤.001). CONCLUSION: Among physicians, subjective evaluation of the TA is more consistent and has better diagnostic sensitivity than that of shadowing for the diagnosis of ureteral stones, and the stone size may play an important role in the detection sensitivity of these 2 indicators.

Efficacy and safety of ultrasound-guided totally implantable venous access ports via the right innominate vein in adult patients with cancer: Single-centre experience and protocol.

BACKGROUND: Totally implantable venous access ports (TIVAPs) are widely used and are an essential tool in the efficient delivery of chemotherapy. This study aimed to evaluate the feasibility and safety of implantation of ultrasound (US)-guided TIVAPs via the right innominate vein (INV) for adult patients with cancer. METHODS: This study retrospectively reviewed the medical records of 283 adult patients with cancer who underwent US-guided INV puncture for TIVAPs between September 2015 and September 2017. It also analysed the technical success rate, operation time, and short-term and long-term surgical complications. RESULTS: Technical success was achieved in all patients (100%). The mean operation time was 28.31 ± 7.31 min (range: 23-39 min), and the puncture success rate for the first attempt was 99.30% (281/283). Minor complications included artery puncture during the operation in one patient, but no pneumothorax was encountered. The mean TIVAP time was 304.16 ± 42.54 days (range: 38-502 days). The rate of postoperative complications was 2.83% (8/283), including poor healing of the incision in one patient, catheter-related infections in three patients, port thrombosis in one patient, and fibrin sheath formation in three patients; no catheter malposition, pinch-off syndrome, catheter fracture, or other serious complications were observed. CONCLUSIONS: TIVAPs are widely employed for chemotherapy. The present study found that the novel approach of using US-guided INV puncture to implant TIVAPs in adult patients with cancer is both short-termly feasible and safe for long-term central venous access.

Comparison of the clinical effectiveness of US grading scoring system vs MRI in the diagnosis of early rheumatoid arthritis (RA).

BACKGROUND: As an irreversible disease, a treatment delay can negatively affect treatment response in rheumatoid arthritis (RA). Ultrasound and MRI have played an important role in assessing disease progression and response to treatment in RA for many years. The present study was designed to compare the diagnostic efficacy of ultrasound grading and MRI in early RA. METHODS: In this retrospective study, 62 early RA patients within 12 months of symptom onset were included. DAS28, rheumatoid factor (RF), CRP, ESR, and anti-cyclic citrullinated peptide antibody (CCP) of the patients were measured. Bilateral hand joints and wrists were examined by ultrasonography (US) and MRI; diagnosis outcome was compared. Relationship between DAS28 scores, laboratory parameters, and ultrasound findings were analyzed. RESULTS: Ultrasound and MRI had an equivalent diagnosis value in synovitis, joint effusion, and tenosynovitis. The detection rate of synovitis, arthroedema, and tenosynovitis on ultrasound and MRI was very close (P > 0.05). The detection rate of bone erosion was lower in ultrasonography than that in MRI (P < 0.05). There were significant differences between power Doppler ultrasonography (PDUS) and gray-scale ultrasonography (GSUS) in the diagnosis of synovitis (χ 2 = 3.92, P < 0.05); the sensitivity of GSUS was better than that of PDUS (P < 0.05). PDUS was positively correlated with DAS28, ESR, CRP, and CCP (P < 0.01), but not correlated with RF and disease duration (P > 0.05). GSUS was positively correlated with RF and CRP (P < 0.01), but not correlated with DAS28, CCP, ESR, and disease duration (P > 0.05). Bone erosion was positively correlated with disease duration, CCP, and RF (P < 0.01) and was not correlated with DAS28, ESR, and CRP (P > 0.05). CONCLUSION: Ultrasonography has a high reliability in the diagnosis of early RA in synovitis, joint effusion, tenosynovitis, and bone erosion. Ultrasonography and clinical and laboratory parameters had a great correlativity. Both ultrasound and MRI are effective techniques. In view of the advantages of low cost and convenience, ultrasound may be a better choice during early RA diagnosis.

Transcranial Sonographic Alterations of Substantia Nigra and Third Ventricle in Parkinson's Disease with or without Dementia.

BACKGROUND: Numerous studies have demonstrated that patients with Parkinson's disease (PD) have a higher prevalence of substantia nigra (SN) hyperechogenicity compared with controls. Our aim was to explore the neuroimaging characteristics of transcranial sonography (TCS) of patients with PD and those with PD with dementia (PDD). The correlation between the echogenicity of the SN and clinical symptoms in Chinese patients with PDD was also assessed. METHODS: The ratios of SN hyperechogenicity (SN+), maximum sizes of SN+, and widths of third ventricle (TV) were measured using TCS for all the recruited patients. Data were analyzed using one-way analysis of variance, rank-sum test, Chi-square test, and receiver-operating characteristic (ROC) curve analysis. RESULTS: The final statistical analysis included 46 PDD patients, 52 PD patients, and 40 controls. There were no significant differences in ratios of SN+ and maximum sizes of SN+ between PDD and PD groups (P > 0.05). TV widths were significantly larger in PDD group (7.1 ± 1.9 mm) than in PD group (6.0 ± 2.0 mm) and controls (5.9 ± 1.5 mm, P < 0.05); however, the ratios of enlarged TV did not differ among the three groups (P = 0.059). When cutoff value was set at 6.8 mm, the TV width had a relatively high sensitivity and specificity in discriminating between PDD and PD groups (P = 0.030) and between PDD group and controls (P = 0.003), based on ROC curve analysis. In PDD patients, SN+ was more frequently detected in akinetic-rigid subgroup, and patients with SN+ showed significantly higher Hoehn and Yahr stage and Nonmotor Symptoms Questionnaire scores (P < 0.05). CONCLUSIONS: Compared to Chinese patients with PD, patients with PDD had a wider TV, altered SN sonographic features, and more severe clinical symptoms. Our findings suggest that TCS can be used to assess brain atrophy in PD and may be useful in discriminating between PD with and without dementia.

Transrectal real-time tissue elastography targeted biopsy coupled with peak strain index improves the detection of clinically important prostate cancer.

The focus of the present study was to evaluate transrectal real-time tissue elastography (RTE)-targeted two-core biopsy coupled with peak strain index for the detection of prostate cancer (PCa) and to compare this method with 10-core systematic biopsy. A total of 141 patients were enrolled for evaluation. The diagnostic value of peak strain index was assessed using a receiver operating characteristic curve. The cancer detection rates of the two approaches and corresponding positive cores and Gleason score were compared. The cancer detection rate per core in the RTE-targeted biopsy (44%) was higher compared with that in systematic biopsy (30%). The peak strain index value of PCa was higher compared with that of the benign lesion. PCa was detected with the highest sensitivity (87.5%) and specificity (85.5%) using the threshold value of a peak strain index of ≥5.97 with an area under the curve value of 0.95. When the Gleason score was ≥7, RTE-targeted biopsy coupled with peak strain index detected 95.6% of PCa cases, but 84.4% were detected using systematic biopsy. Peak strain index as a quantitative parameter may improve the differentiation of PCa from benign lesions in the prostate peripheral zone. Transrectal RTE-targeted biopsy coupled with peak strain index may enhance the detection of clinically significant PCa, particularly when combined with systematic biopsy.

Sonographic Alteration of Basal Ganglia in Different Forms of Primary Focal Dystonia: A Cross-sectional Study.

BACKGROUND: Few studies have addressed whether abnormalities in the lenticular nucleus (LN) are characteristic transcranial sonography (TCS) echo features in patients with primary dystonia. This study aimed to explore alterations in the basal ganglia in different forms of primary focal dystonia. METHODS: cross-sectional observational study was performed between December 2013 and December 2014 in 80 patients with different forms of primary focal dystonia and 55 neurologically normal control subjects. TCS was performed in patients and control subjects. Multiple comparisons of multiple rates were used to compare LN hyperechogenicity ratios between control and patient groups. RESULTS: Thirteen individuals were excluded due to poor temporal bone windows, and two subjects were excluded due to disagreement in evaluation by sonologists. Totally, 70 patients (cervical dystonia, n = 30; blepharospasm, n = 30; oromandibular dystonia, n = 10) and 50 normal controls were included in the final analysis. LN hyperechogenicity was observed in 51% (36/70) of patients with primary focal dystonia, compared with 12% (6/50) of controls (P < 0.001). Substantia nigra hyperechogenicity did not differ between the two groups. LN hyperechogenicity was observed in 73% (22/30) of patients with cervical dystonia, a greater prevalence than in patients with blepharospasm (33%, 10/30, P = 0.002) and oromandibular dystonia (40%, 4/10, P = 0.126). LN hyperechogenicity was more frequently observed in patients with cervical dystonia compared with controls (73% vs. 12%, P < 0.001); however, no significant difference was detected in patients with blepharospasm (33% vs. 12%, P = 0.021) or oromandibular dystonia (40% vs. 12%, P = 0.088). CONCLUSIONS: LN hyperechogenicity is more frequently observed in patients with primary focal dystonia than in controls. It does not appear to be a characteristic TCS echo feature in patients with blepharospasm or oromandibular dystonia.